Methods and apparatus for implanting an interbody device

ABSTRACT

An interbody implant comprises one or more elongate members that have superior and inferior surfaces with a height, and medial and lateral surfaces having a width. The height is set so the implant fits into the intervertebral space. The width is less than the height. The interbody implant has a first configuration, a second configuration, and a third configuration. The interbody implant is inserted into the intervertebral space in the first configuration such that medial and lateral surfaces contact the vertebral bodies, and the interbody implant is then actuated into the second configuration such that superior and inferior surfaces engage the vertebral bodies. Actuation of the implant from the first configuration to the second configuration distracts the vertebral bodies. The implant is actuated into the third configuration where the width of the implant is greater than width of the implant in the first or the second configuration.

CROSS-REFERENCE

The present application is a continuation application of U.S.Non-Provisional patent application Ser. No. 14/322,702 (Attorney DocketNo. 44057-706.201) filed on Jul. 2, 2014, which is a non-provisional of,and claims the benefit of U.S. Provisional Patent Application No.61/842,888 (Attorney Docket No. 44057-706.101) filed on Jul. 3, 2013;the entire contents of which are incorporated herein by reference.

The present application is related to U.S. patent application Ser. No.14/322,589 filed Jul. 2, 2014; the entire contents of which areincorporated herein by reference.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The present invention generally relates to medical devices and methods,and more particularly relates to interbody devices and methods of use.Interbody devices may be used for supporting and facilitating fusion ofadjacent vertebrae in a patient's spine.

Various interbody fusion devices such as fusion cages may be implantedin the intervertebral disc space. These devices facilitate fusion of theadjacent vertebrae together and support the adjacent vertebral bodies.Depending on the size of the interbody fusion device and thecorresponding delivery instrument, a surgeon may have to remove bone inorder to provide adequate space. Clearly, it would be desirable if boneremoval could be minimized or eliminated all together. Moreover,adjacent tissue may also need to be retracted or removed, and it wouldbe desirable to minimize or eliminate this as well. Also, insertion ofthe implant often requires distraction of the vertebrae, therefore itwould be desirable to provide a low profile implant that minimizes theamount of distraction required.

Newer interbody fusion devices are being developed which have a smallermore compact profile for delivery and a larger expanded profile afterdeployment. The smaller delivery size facilitates delivery, and thelarger deployed configuration facilitates support and fusion of thebone. Therefore, it would be desirable to provide an interbody devicethat has an even smaller profile for delivery, and an even largerprofile after implantation into the intervertebral disc space. At leastsome of these objectives will be satisfied by the devices and methodsdisclosed below.

2. Description of the Background Art

The following US patents and patent publications are related tointerbody devices: 2013/0103156; 2012/0083887; 2012/0083889;2012/0310350; U.S. Pat. Nos. 8,317,866; 7,870,905; 6,395,031; 6,833,066;7,655,042; and 7,993,403.

SUMMARY OF THE INVENTION

The present invention generally relates to medical devices and methods,and more particularly relates to interbody devices and methods of use.Interbody devices may be used for supporting and facilitating fusion ofadjacent vertebrae in a patient's spine.

In a first aspect of the present invention, an interbody implant forimplanting in an intervertebral space surrounded by adjacent vertebralbodies in a patient during spinal fusion comprises one or more elongatemembers that form the implant. The one or more elongate members havesuperior and inferior surfaces with a height therebetween, and medialand lateral surfaces with a width therebetween. The superior andinferior surfaces are shaped to engage the vertebral bodies, and theheight is set at a predetermined distance that is sized to fit into theintervertebral space. The width is set at a predetermined distance lessthan the predetermined height. The interbody implant has a firstconfiguration, a second configuration, and a third configuration. Theinterbody implant is inserted into the intervertebral space in the firstconfiguration such that medial and lateral surfaces contact thevertebral bodies. The interbody implant is actuated into the secondconfiguration such that superior and inferior surfaces engage thevertebral bodies, and actuation of the implant from the firstconfiguration to the second configuration distracts the vertebral bodiesaway from one another to increase the intervertebral space. The implantis actuated into the third configuration where the width of the implantis greater than width of the implant in the first or the secondconfiguration.

The second configuration may have the same width and height as the firstconfiguration. The one or more elongate members may comprise twoelongate members, and actuation of the implant from the secondconfiguration to the third configuration may be obtained by translationof the two elongate members away from one another. The two elongatemembers may be coupled together with one or more spanning componentsthat deform between the second and the third configurations.

The two elongate members may be coupled together with one or morespanning components, and the two elongate members may translate alongthe one or more spanning components. The one or more spanning componentsmay comprise a first spanning component and a second spanning component.The first spanning component may face in a first direction, and thesecond spanning component may face in a second direction opposite thefirst direction. The first spanning component may be disposed over thesecond spanning component. The one or more spanning components may be atleast partially disposed in a recessed region of the one or moreelongate members. At least one of the one or more spanning componentsmay comprise a first arm and a second arm. Each arm may have a free endand a hinged end. The hinged ends may be coupled together with a hinge.Each arm may further comprise a supplemental hinge disposed between thefree end and the hinged end. The supplemental hinge may be configured toallow the free end to bend independently of the hinged end. At least oneof the one or more spanning components may comprise one or moreapertures disposed in an arm of the spanning component. The one or moreapertures may be sized to receive a pin. The one or more spanningcomponent may consist of only one spanning component.

The one or more spanning components may comprise a locking feature, andthe two elongate members may lock into the third configuration when thetwo elongate members engage the locking feature. The one or morespanning components may comprise a plurality of assembled componentsconfigured to telescope over one another thereby allowing the twoelongate members to translate relative to one another. The one or moreelongate members may comprise an engagement feature configured to allowthe one or more elongate members to be releasably coupled to aninsertion instrument, and the insertion instrument may be actuatable.Actuation of the insertion instrument may actuate the implant from thesecond configuration to the third configuration.

The one or more elongate members may comprise a first elongate memberand a second elongate member. The implant may further comprise aposterior cap that is engaged with the first and second elongate membersand that is configured to hold the elongate members in the thirdconfiguration. At least some of the superior or inferior surfaces of theone or more elongate members may comprise anti-migration teeth.

In another aspect of the present invention, an interbody implant forimplanting in an intervertebral space surrounded by adjacent vertebralbodies in a patient during spinal fusion comprises a plurality ofelongate members that form the implant, and one or more spanning membersthat are coupled with the plurality of elongate members. The pluralityof elongate members have superior and inferior surfaces with a heighttherebetween, and medial and lateral surfaces have a width therebetween.The superior and inferior surfaces are shaped to engage the vertebralbodies, and the height is set at a predetermined distance that is sizedto fit into the intervertebral space. The width is set at apredetermined distance less than the predetermined height. The interbodyimplant has a first configuration, a second configuration, and a thirdconfiguration. The interbody implant is inserted into the intervertebralspace in the first configuration such that medial and lateral surfacescontact the vertebral bodies, and the interbody implant is actuated intothe second configuration such that the superior and inferior surfacesengage the vertebral bodies and distract the vertebral bodies away fromone another. In the third configuration the width is greater than thewidth in the first or the second configuration, and actuation from thesecond configuration to the third configuration comprises translation ofthe one or more elongate members laterally away from one another.

The plurality of elongate members may be coupled together with the oneor more spanning members and that may deform between the second andthird configurations. The one or more spanning components may comprise afirst spanning and a second spanning component. The first spanningcomponent may face in a first direction, and the second spanningcomponent may face in a second direction opposite the first direction.The first spanning component may be disposed over the second spanningcomponent. The one or more spanning components may be at least partiallydisposed in a recessed region of the one or more elongate members. Atleast one of the one or more spanning components may comprise a firstarm and a second arm. Each arm may have a free end and a hinged end. Thehinged ends are coupled together with a hinge. Each arm may alsocomprise a supplemental hinge disposed between the free end and thehinged end. The supplemental hinge may be configured to allow the freeend to bend independently of the hinged end. AT least one of the one ormore spanning components may comprise one or more apertures disposed inan arm of the spanning component, and the aperture may be sized toreceive a pin. The one or more spanning components may consist of onlyone spanning component.

The plurality of elongate members may be coupled together with the oneor more spanning components, and the plurality of elongate members maytranslate along the one or more spanning components. The one or morespanning members may comprise locking features, and the plurality ofelongate members may lock into the third configuration when theplurality of elongate members engage the locking features. The one ormore spanning members may comprise a plurality of assembled componentsconfigured to telescope over one another thereby allowing the pluralityof elongate members to translate relative to one another. The pluralityof elongate members may comprise an engagement feature configured toallow the plurality of elongate members to be releasably coupled to aninsertion instrument. The insertion instrument may be actuatable andwherein actuation of the insertion instrument may actuate the implantfrom the second configuration to the third configuration.

The plurality of elongate members may comprise a first elongate memberand a second elongate member. The implant may further comprise aposterior cap that is engaged with the first and second elongate membersand the cap may be configured to hold the elongate members in the thirdconfiguration. At least some of the superior or inferior surfaces of theplurality of elongate members comprise anti-migration teeth.

In yet another aspect of the present invention, a method for deliveringan interbody implant into an intervertebral space of a patient comprisesinserting an interbody implant into the intervertebral space in a firstconfiguration, actuating the interbody implant from the firstconfiguration to a second configuration such that the interbody implantdistracts the intervertebral space to a greater height when theinterbody implant is in the second configuration, and actuating theinterbody implant from the second configuration to a thirdconfiguration, wherein in the third configuration implant widthincreases relative to width of the implant in the first configuration.

Actuating the interbody implant from the first configuration to thesecond configuration may comprise rotating the interbody implant in theintervertebral space. Actuating the interbody implant from the secondconfiguration to the third configuration may comprise expanding two ormore elongate members away from one another. Expanding the two or moreelongate members may comprise expanding two elongate members away fromone another and the two expanded elongate members may remainsubstantially parallel with one another after expansion. The method mayfurther comprise locking the interbody implant in the thirdconfiguration. Locking the interbody implant may comprise engaging a capagainst a posterior portion of the interbody implant. Actuating theinterbody implant from the second configuration to the thirdconfiguration may comprise actuating an expansion instrument. Theexpansion instrument may comprise a wedged tip and actuating theinterbody implant may comprise inserting the wedged tip into theinterbody implant thereby causing expansion of the interbody implant.The interbody implant may be coupled to a delivery instrument and themethod may further comprise releasing the interbody implant from thedelivery instrument. The first configuration may comprise a collapsedconfiguration and inserting the interbody implant into theintervertebral space in the collapsed configuration may comprisecoupling the interbody implant with an elongate shim, coupling theelongate shim with an insertion instrument, advancing the insertioninstrument toward the intervertebral space, and disposing the interbodyimplant in the intervertebral space. Actuating the interbody implantfrom the first configuration to the second configuration may compriserotating the insertion instrument thereby rotating the interbodyimplant. Actuating the interbody implant from the second configurationto the third configuration may comprise uncoupling the insertioninstrument from the elongate shim, coupling an expansion instrument withthe elongate shim, and advancing a wedged portion of the expansioninstrument into the interbody implant thereby expanding the interbodyimplant.

In still another aspect of the present invention, a system fordelivering an interbody implant into an intervertebral space of apatient, comprises an interbody fusion device and an elongate shimhaving a proximal end and a distal end, wherein the distal end comprisesan engagement element for releasably coupling the interbody fusiondevice. The proximal end is configured to engage a surgical instrument.

The interbody fusion device may comprise a receptacle having a shoulder,and the engagement element comprises an angled protrusion with a flatshoulder, the angled protrusion configured to be advanced into thereceptacle in the interbody fusion device and the flat shoulder of theengagement element engages the shoulder of the receptacle. The systemmay further comprise an insertion instrument having an elongate shaftwith a central channel therethrough and a handle disposed on a proximalportion of the elongate shaft. The central channel may be sized toreceive the elongate shim. The system may also comprise an expansioninstrument having an elongate shaft and an expansion wedge near thedistal portion of the elongate shaft. The expansion wedge may beconfigured to be advanced into the interbody fusion device therebycausing the interbody fusion device to expand. The expansion instrumentmay also have a proximal portion of the elongate shaft configured to beengaged with a handle.

These and other embodiments are described in further detail in thefollowing description related to the appended drawing figures.

INCORPORATION BY REFERENCE

All publications, patents, and patent applications mentioned in thisspecification are herein incorporated by reference to the same extent asif each individual publication, patent, or patent application wasspecifically and individually indicated to be incorporated by reference.

BRIEF DESCRIPTION OF THE DRAWINGS

The novel features of the invention are set forth with particularity inthe appended claims. A better understanding of the features andadvantages of the present invention will be obtained by reference to thefollowing detailed description that sets forth illustrative embodiments,in which the principles of the invention are utilized, and theaccompanying drawings of which:

FIG. 1 is a perspective view of an exemplary embodiment of an interbodyfusion device in the collapsed configuration.

FIG. 2 is a perspective view of the embodiment in FIG. 1 after it hasbeen expanded.

FIG. 3 is a top view of the embodiment in FIG. 2.

FIG. 4 illustrates a perspective view of a spanning component from theembodiment of FIG. 1.

FIG. 5 illustrates a partial cross-section of the interbody fusiondevice in FIG. 1.

FIG. 6 illustrates a perspective view of another exemplary embodiment ofan interbody fusion device.

FIG. 7 illustrates a perspective view of the embodiment in FIG. 6 whilein the collapsed configuration.

FIG. 8 illustrates a partial cross-section through the embodiment ofFIG. 6.

FIG. 9 illustrates a perspective view of another exemplary embodiment ofan interbody fusion device in the expanded configuration.

FIG. 10 is a top view of the embodiment in FIG. 9.

FIG. 11 illustrates a perspective view of still another exemplaryembodiment of an interbody fusion device in the collapsed configuration.

FIG. 12 illustrates a perspective view of the embodiment of FIG. 11 inthe expanded configuration.

FIG. 13 illustrates a partial cross-section of the embodiment in FIG.11.

FIG. 14 illustrates a side view of an interbody fusion device disposedin the intervertebral disc space.

FIG. 15 illustrates a side view of the interbody fusion device in FIG.14 rotated 90 degrees.

FIG. 16 illustrates a side view of the interbody fusion device in FIG.15 in the expanded configuration.

FIG. 17 illustrates a perspective view an interbody implant coupled toan insertion guide device.

FIGS. 18A-18F illustrate a side view of insertion of the insertion guidedevice into the intervertebral disc space and delivery of an interbodyimplant.

FIGS. 19A-19B illustrate a perspective view of a pusher element forpushing an interbody implant from the insertion guide device.

FIGS. 20A-20E illustrate perspective or partial cross-sectional views ofother features of exemplary embodiments of the interbody fusion device.

FIGS. 21A-21G illustrate perspective, partial cross-sectional, or topviews of various aspects of other exemplary embodiments of the interbodyfusion device.

FIGS. 22A-22D illustrate perspective, top or partial cross-sectionalviews of aspects of another exemplary embodiment of an interbody fusiondevice.

FIGS. 23A-23E illustrate perspective or top views of features of stillanother exemplary embodiment of an interbody fusion device.

FIGS. 24A-24C illustrate perspective or partial cross-sectional views ofengagement of an interbody fusion device with a shim used to advance theimplant with an insertion instrument.

FIGS. 25A-25B illustrate a perspective view of an exemplary embodimentof an insertion tool.

FIGS. 26A-26E illustrate a perspective view of various features ofseveral embodiments of an expansion tool.

FIGS. 27A-27C illustrate a top view of implantation of an interbodyfusion device.

FIG. 28 illustrates a perspective view of the removal of the insertioninstrument from the implant.

FIG. 29 illustrates a perspective view of the engagement of expansioninstrument with the implant.

FIG. 30 illustrates a perspective view of the assembly in FIG. 29 withhandle engagement.

FIG. 31 illustrates a perspective view of the assembly in FIG. 30 duringexpansion.

FIG. 32 illustrates a perspective view of the embodiment in FIG. 30after the expansion instrument has been removed.

DETAILED DESCRIPTION OF THE INVENTION

Specific embodiments of the disclosed device and method of use will nowbe described with reference to the drawings. Nothing in this detaileddescription is intended to imply that any particular component, feature,or step is essential to the invention.

Interbody Fusion Devices.

FIG. 1 is a preferred embodiment of the interbody device (also referredto as the implant) where the elongated members 20 are connected by twospanning components 30. One is adjacent a superior surface of theinterbody device and the other is adjacent the inferior surface of theinterbody device. This embodiment is designed to be inserted into thedisc space in one configuration with the smooth walls 27 contacting theendplates, rotated into a second configuration where the top and bottomsurfaces 21 contact the endplates, and then expanded in width to a thirdconfiguration where the smooth walls 27 are at a greater distance apartthan they are in the second configuration. The distance between thesmooth walls 27 is less than the distance between the top and bottomsurfaces 21 so that when the implant is rotated from the firstconfiguration into the second configuration it distracts the disc space.In this embodiment of the implant, the spanning members are designed todeform during the width expansion so they have been made withdeformation zone 31 of supplemental hinge 35 and deformation zone 32 ofhinge. The spanning components 30 fit into a recessed pocket 26 that isformed in the top or bottom surfaces 21 of the elongated members 20 whenthey are in their collapsed state. The top and bottom surfaces 21 areequipped with anti-migration teeth that allow for translation of theelongated members 20 during width expansion but help to preventtranslation of the device along the longitudinal axis of the elongatedmembers 20. The elongated members have angled surfaces 25 that form atapered end for easier introduction into the disc space. In order toaide in the rotation of the implant, two corners of the implant havebeen chamfered 24. In order to facilitate the insertion, rotation, andwidth expansion, of the implant, a slot 23 and a rectangular end 22 aredesigned to mate with an insertion instrument.

FIG. 2 shows the implant in the expanded configuration with theelongated elements 20 translated relative to one another and thespanning components 30 in their deformed states with deformation havingoccurred at deformation zone 31 of supplemental hinge 35 and deformationzone 32 of hinge. The elongated elements 20 may be parallel with oneanother in the expanded configuration, or they may be transverse to oneanother. Also visible in FIG. 2 is notch 28 which is designed to engagewith the insertion instrument.

FIG. 3 is a top view of the implant in the expanded state with bothelongated members and spanning components 30 clearly visible. Thespanning components (also referred to herein as spanning members) 30 arepositioned on opposite ends of one another and are configured inopposite directions for a uniform expansion. Therefore, in thisembodiment one spanning component has first and second arms connectedtogether with a hinge that opens up an forms an angle facing in onedirection, and the other spanning component also has first and secondarms that are connected together with a hinge that opens up and forms anangle facing in the opposite direction as the other spanning component.

FIG. 4 shows the spanning components separate from the implant. Fourengagement pins 33 and snap features 34 are designed to attach thespanning components 30 to the elongated members 20.

FIG. 5 shows a cross-section of the elongated member 20 where theattachment holes 29 that engage with the pins 33 and snap features 34 ofthe spanning members 30 are shown. Two pins on each arm of the spanningmembers are used in order to prevent unwanted pivoting at the connectionpoint.

FIG. 6 shows an additional embodiment of the implant where the elongatedmembers 40 are attached with two spanning members 50 that lock theelongated members 40 in their expanded configuration via mating geometryin the both the spanning members 50 and the elongated members 40 and aset of c-clips 60 as will be described below.

FIG. 7 shows the implant of FIG. 6 in its collapsed state with a taperedend 43, smooth side walls 40, top and bottom surfaces 42, and aninstrument engagement feature 41. The tapered end 43 facilitatesinsertion into the intervertebral space.

In FIG. 8 a cross-section of FIG. 7 taken through the spanning member 50and this view shows the elongated members 40 with pockets 45 for thec-clips 60 and the spanning member with locking grooves 51. In theexpanded width the c-clips 60 lock into the locking grooves 51 on thespanning members 50. Thus, the c-clips expand and contract such thatwhen they move into the locking grooves they prevent motion. Alsovisible in FIG. 8 are curved corners 46 that help facilitate therotation from the first configuration to the second configuration.

FIG. 9 shows another exemplary embodiment of the implant where thespanning components 80 and 90 telescope relative to each other to allowfor greater translation of the elongated members 70. FIG. 9 shows thedevice in its expanded state with smooth side walls 73, top and bottomsurfaces 71, and instrument engagement feature 72.

In FIG. 10 the embodiment of FIG. 9 is shown from a top view in theexpanded state. Slot 82 in the first spanning component 80 allows forthe telescoping of the second spanning component 90. Snap feature 81locks the first spanning component 80 and the second spanning component90 relative to one another when in the expanded state.

FIG. 11 shows an additional embodiment where the elongated members 100have top and bottom surfaces 101 with a plurality of anti-migrationteeth, smooth side walls 103, and instrument engagement features 104. Inthis embodiment of the interbody, the spanning components 110 consist offour ratcheting members. In the collapsed state the spanning components110 are positioned in dovetailed slots 102 along the smooth side walls103 in the elongated members 100. The slots 102 and the spanningcomponents 110 have corresponding dovetail profiles to retain thespanning members 110 in their corresponding slot 102. The spanningmembers 110 are attached to the elongated members 100 via a series ofpins 120 that traverse through both the elongated members 100 and thespanning components 110.

FIG. 12 shows the implant of FIG. 11 in its expanded state. The ratchetteeth 111 on the spanning components 110 engage with the lock component130 to fix the implant in its expanded position. The lock components 130are attached to the elongated members 100 via the lock fixation pins 140with the heads of the lock fixation pins being set in a recess 105 inthe elongated members 100 when in the collapsed state. In order for thespanning components 110 to move from their position in the collapsedstate into their position in the expanded state they will need toelastically deform during the time when they transition from being inthe slots 102 in the elongated members 100 to being perpendicular to thesmooth side walls 103 and spanning between the elongated members 100.

FIG. 13 shows a cross section of the implant in FIG. 11 at the medialwall of the elongated member 100. Visible in this cross section are thespanning components 110, the lock 130, and the lock fixation pins 140.Also visible are the interaction between the locks 130 and the spanningmembers 110 at junction 131 where the lock ratchets along the ratchetteeth 111 in the spanning components 110.

FIGS. 20A-20E illustrate various features of other exemplaryembodiments. FIG. 20A is a perspective view of an exemplary embodimentof the interbody fusion device (also referred to as the implant) in thecollapsed configuration. The implant includes two elongated members 210that are attached with two spanning members 175 stacked on top of oneanother. The elongated members 210 include a relief cut 180 that issized to receive the spanning components and alleviates loading ofspanning components 175. Receptacle 181 is formed when the two elongatemembers are in the collapsed configuration and allow a surgicalinstrument to be coupled thereto, as will be discussed elsewhere in thisspecification.

FIG. 20B illustrates a cross-section of FIG. 20A taken through elongatedmember 210. This view illustrates how the spanning member 175 is coupledto the elongate member 210. The posts 177 on the spanning members 175and cross pins 176 are designed to attach the spanning components 175 tothe elongated members 210. The spanning member is seated in recess 180.

FIG. 20C is a perspective view illustrating the spanning member 175 moreclearly. The spanning component 175 consists of two engagement posts 177and two holes 178 to engage with pins 176. The spanning component isformed from two arms coupled together with a hinge that allows the armsto open or close. A relief cut in both arms allows the free end of thearms to pivot inwardly or outwardly thereby permitting the elongatemembers to remain substantially parallel with one another as they openup outward.

FIG. 20D illustrates the interbody fusion device in the expanded ordistracted configuration with the spanning component also in theexpanded configuration. An optional posterior cap 179 may be coupled tothe elongated members 210 in order to lock the implant into the expandedconfiguration. A surgeon may use forceps or another surgical instrumentto engage the posterior cap with the elongate members. The posterior capmay have a snap fit, press fit, or other coupling mechanism forattachment to the elongate members. In addition to locking the implantin the expanded configuration, the posterior cap also adds stability tothe implant and also aids in containment of bone grafting material. FIG.20E is a rear view of the implant in FIG. 20D and highlights theposterior cap 179.

FIGS. 21A-21G illustrate various aspects of other exemplary embodimentsof the implant. FIG. 21A is a perspective view of an interbody fusiondevice in the expanded configuration. The implant has two elongatedmembers 201 that are attached with two spanning members 202. Spanningmembers 202 are disposed in a recessed pocket 203 that is formed in thecenter of the elongated members 201 when they are in their collapsedstate. Spanning members 202 are attached to elongated members 201 viacross pins 204.

FIG. 21B illustrates the interbody fusion device of FIG. 21A in thecollapsed configuration. Receptacle 208 is formed when the elongatemembers 201 are collapsed. Receptacle 208 allows the implant to becoupled to other surgical instruments as will be discussed elsewhere.

FIG. 21C illustrates a cross-section of the embodiment in FIG. 21A. Thecross-section is taken through elongated member 201. This viewhighlights the engagement between elongated member 201, cross pins 204and spanning components 202.

FIG. 21D illustrates a spanning component from the embodiment of FIG.21A. Two holes 205 are designed to fit cross pins 204 to attach to theimplant. In this embodiment, the spanning members are designed to deformat deformation zone 206 and pivot around cross pins 204 during widthexpansion. The cross member (also referred to as a spanning member)includes two arms coupled together with a hinge. The free end of eacharm includes the hole 205 for receiving a pin.

FIG. 21E illustrates the orientation of the two spanning members 202relative to one another in the embodiment of FIG. 21A. In thisembodiment, the upper spanning member has an open end and a closed endfacing in a first direction. The lower spanning member has an open endand a closed end facing in a second direction opposite the firstdirection. Pins 204 are also show in the holes of each spanning member.

FIG. 21F illustrates an alternative embodiment of the interbody fusiondevice of FIG. 21A. In the embodiment of FIG. 21A, the holes in theelongate member and the pins for each spanning member are disposed onthe same side of the elongate member. In FIG. 21F, one hole is on asuperior surface of the implant and the second hole is on the inferiorsurface of the implant. Thus the corresponding pins also are pressed infrom opposite sides of the implant. One is pressed in from the superiorsurface and the other from the inferior surface. Similarly, the secondspanning member has one pin pressed in from each side of the elongatemember.

FIG. 21G illustrates a top view of the embodiment in FIG. 21F with thestagger pin configuration.

FIGS. 22A-22D illustrate aspects of another exemplary embodiment of aninterbody fusion device. FIG. 22A illustrates a perspective view of theimplant in the collapsed configuration. Here, the elongated members 209are attached with only one spanning member 202. Spanning member 202 fitsinto a recessed pocket 203 that is formed in the center of each of theelongated members 209 when they are in their collapsed state. Spanningmember 202 is attached to the elongated members 201 via cross pins 204.

FIG. 22B illustrates a top view of the interbody fusion device in FIG.22A. FIG. 22C shows a cross-section of the elongate member 201, showingthe engagement between elongated member 209, cross pins 204 and spanningmember 202.

FIG. 22D illustrates the spanning member 202 which includes two armsconnected together with a hinge. The free ends of the arms include holesfor receiving the pins 204.

FIGS. 23A-23E illustrate features of another exemplary embodiment of aninterbody fusion device. FIG. 23A illustrates a perspective view of theinterbody fusion device in the collapsed configuration. In thisembodiment, the elongated members 211 are coupled together with twospanning members 212. A receptacle 214 allows the implant to be engagedwith a surgical instrument for delivery, as will be discussed elsewherein this specification. The superior and inferior surfaces of the implantoptionally have anti-movement teeth, and this feature may optionally beincluded in any of the embodiments of implants disclosed herein.

FIG. 23B illustrates the implant of FIG. 23A in the expandedconfiguration. FIG. 23C shows a cross-section of the implant in FIG. 23Ain the expanded configuration. The cross-section is taken throughspanning component 212. Cross pins 213 attach spanning components 212 toelongated members 211 and allow pivotal motion about the longitudinalaxis of elongated members 211.

FIG. 23D illustrates the spanning member 212 in more detail. Thespanning member 212 includes two arms connected together with a hinge.The free ends of the arms each have holes 216 for receiving cross pins213 for securing the spanning member 212 to the elongate member. Inaddition the main hinge, each arm has an arcuate cutout region whichforms a secondary hinge 215. The secondary hinge allows the arm tofurther bend independently of the main hinge, such as in the case whenthe elongate members expand outward, they can remain in a substantiallyparallel configuration.

FIG. 23E illustrates both spanning members stacked on top of one anotheras they would be in the implant of FIG. 23A with the cross-pins insertedin holes 216. A portion of both arms in each spanning member forms anangle with the main hinge, and the secondary hinge allows the free endof the arm to bend inward toward the opposite free end of an arm,thereby permitting the free ends of both arms to remain substantiallyparallel to one another. This allows the elongate members to also remainsubstantially parallel to one another in the expanded configuration.

Implantation.

FIG. 14 show a superior vertebral body 150, an inferior vertebral body160, and the intervertebral space 180 between them. The superiorarticular process 161 of the inferior vertebral body 160 and theinferior articular process 151 of the superior vertebral body 150 havebeen removed on one side to allow for access into the intervertebralspace as is common in a transforaminal interbody fusion procedure(TLIF). FIG. 14 shows the implant 170 being inserted in to theintervertebral space 180 with the smooth side walls contacting theendplates of the vertebral bodies 150 and 160. The implant 170 may beany of the embodiments of implants disclosed herein.

FIG. 15 shows the implant rotated 90 degrees so that the top and bottomsurfaces of the implant 172 are contacting the endplates of thevertebral bodies. Due to the difference in the height of the implantrelative to the width of the implant this rotation results in thedistraction of the vertebral bodies 150 and 160.

FIG. 16 shows the implant 170 in an expanded state creating a wider andmore stable footprint for the implant and ample room for the insertionof graft material into the space created in the implant 173. The implantin this exemplary method of implantation may be any of those describedherein.

FIGS. 18A-18F illustrate an exemplary method of delivering an interbodyimplant using an insertion guide device such as the one illustrated inFIG. 17.

In FIG. 18A, the insertion guide device 1802 is inserted into theintervertebral disc space between adjacent vertebrae V. In FIG. 18B, theinterbody implant 1804 is advanced distally out of the insertion guidedevice 1802 until it is exposed from the expandable portion of theinsertion guide device and positioned in a desired location between thevertebrae, as illustrated in FIG. 18C. The anti-migration teeth of theupper and lower surfaces of the implant face laterally and mediallyoutward and the smooth lateral surfaces face upward and downward andengage the vertebral end plates. FIG. 18D is similar to FIG. 18C butillustrates a longer portion of the insertion guide device.

In FIG. 18E, the interbody implant and the insertion guide device havebeen rotated 90 degrees so that the textured surfaces of the interbodyimplant are in engagement with the endplates of the vertebrae and thesmooth lateral surfaces of the implant now face laterally and mediallyoutward. FIG. 18F is a top view of the interbody implant and insertionguide device with the upper vertebra removed for ease in viewing.Additionally, the interbody implant has been laterally expanded toincrease its width. The implant and the insertion guide device may beany of the embodiments disclosed herein.

FIGS. 27A-27C illustrate other aspects of implant delivery anddeployment. FIG. 27A shows a top view of an implant engaged with aninsertion instrument 183 on an inferior vertebral body 198. The superiorvertebrae has been omitted from the figure for convenience. The implanthas been inserted into the intervertebral disc space with the smoothside walls 199 contacting the endplates. The insertion tool may be usedto deliver the implant, or the insertion tool may be used in conjunctionwith the insertion guide previously described above.

FIG. 27B shows the implant rotated 90 degrees so that the top and bottomsurfaces 200 of the implant are contacting the endplates of thevertebral bodies. The top and bottom surfaces preferably haveanti-migration teeth to prevent unwanted movement. Rotation isaccomplished by rotating the insertion tool.

FIG. 27C shows the interbody fusion device disengaged from the insertiontool and now engaged with the expansion instrument. The expansioninstrument has been advanced distally thereby expanding the implant intothe expanded configuration. The expansion instrument 187 and shims 181are still coupled to the implant. After proper positioning and expansionhave been confirmed, the expansion instrument and the shims may beremoved.

Surgical Instruments.

FIG. 17 illustrates an interbody implant 1792 coupled to the insertionguide device 1794. The interbody implant is in its collapsedconfiguration, and it may be any of the embodiments disclosed herein.The insertion guide device may be any of the embodiments disclosed inthis specification, or disclosed in U.S. patent application Ser. No.14/322,589 filed Jul. 2, 2014, and previously incorporated herein byreference. The insertion guide device preferably includes a pair ofelongate insertion plates with a resilient member disposed thereover.The implant is passed through a channel formed by the elongate insertionplates, the resilient member expands to accommodate the implant.

FIGS. 19A-19B illustrate the pusher element which may be advanced orretracted by an operator to move the interbody implant through theinsertion guide device previously described. In FIG. 19A, the pusherelement 1902 includes an elongate shaft with a handle on the proximalend for ease in manipulation. A lever 1904 helps lock the pusher to theinterbody implant. FIG. 19B illustrates the interbody implant 1906coupled to the pusher element 1902. A leaf spring is disposed under theactuation lever thereby biasing the lever in the up position so that thepusher remains locked with the interbody implant. When the lever ismoved, the implant may be decoupled from the pusher.

FIGS. 24A-24C illustrate engagement of the interbody fusion device witha shim used to advance the implant along an insertion instrument. FIG.24A illustrates a perspective view of a shim used to engage any of theinterbody fusion devices described herein. The shim 181 includes anelongate shaft having a mating feature 182 on a distal portion of theelongate shaft and that is configured to engage with any interbodyfusion device, such as notch 28 as seen in FIG. 2, or any of thereceptacles described herein, such as receptacle 214 in FIG. 23A. Theproximal end of the shim includes notches for engagement with aninsertion tool.

FIG. 24B shows engagement of the shim 181 with any interbody fusiondevice disclosed herein. The mating feature 182 on the shim isreleasably coupled with the corresponding notch, receptacle, or othermating feature on the implant.

FIG. 24C illustrates a cross-section in greater detail showingengagement of the shim 181 mating feature 182 with the implant. Here twoshims 181 are illustrated. Shims 181 fit in slot 23 of the implant andengage with the implant in notch 28. The mating feature of the shim inthis embodiment includes an enlarged head having an angled protrusionthat is configured to be advanced forward into the implant and into thecorresponding receptacle, but cannot easily be pulled out when theimplant is in the collapsed configuration because the receptacle has aflat shoulder which engages the flat portion of the angled protrusionand prevents it from pulling out.

FIGS. 25A-25B illustrate an exemplary embodiment of an insertion toolthat may be used in conjunction with the shims previously describedabove to deliver any of the interbody fusion devices described herein toa treatment site. Insertion instrument 183 includes an elongate shafthaving a proximal end and distal end. A handle having a plurality ofposts 185 extending radially outward forming a T-shaped handle isdisposed on the proximal portion of the elongate shaft. The centralportion of the shaft between the proximal and distal portions may berectangular or square with cutouts passing through the wall of the shaftto lessen the weight of the device and also to permit an operator to seecomponents passing through a central channel disposed in the shaft. Thedistal portion of the shaft may have a cylindrical portion. Insertioninstrument 183 consists of a slot 184 that allows for engagement withthe shims previously describe above such as shims 181 in FIG. 24A. Thehandle allows an operator to manipulate the insertion instrument,including rotating the instrument. Engagement feature 186 is configuredto mate with the implant, such as rectangular end 22 in FIG. 1.

FIG. 25B illustrates the insertion instrument of FIG. 25A engaged withan interbody fusion device such as any of those described herein. Theshims are coupled to the implant and they are disposed in the centralchannel of the elongate shaft.

FIGS. 26A-26E illustrate various features of several embodiments of anexpansion tool used to expand the implant from the collapsedconfiguration to the expanded or distracted configuration. FIG. 26Ashows a perspective view of an expansion instrument 187. Expansioninstrument 187 includes an elongate shaft having a proximal end and adistal end. Near the proximal end, slots 188 are configured to form achannel that engages the shims previously disclosed above. The elongateshaft includes a rectangular shaft 191 that may engage with a handlesuch as that seen in FIG. 26B and used during expansion of the implant.Expansion instrument 187 has angled surfaces 189 that form a tapered endfor easier introduction between the elongated members of the implant.Threaded component 190 allows for controlled expansion of the implant.

FIG. 26B illustrates a perspective view of a handle that may be usedwith the expansion instrument in FIG. 26A. The handle includes a matingthread 193 to engage with threaded component 190, and rectangular slot194 allows for translation of rectangular shaft 191 of expansioninstrument 187 through the handle. Slot 196 allows for insertion of shim181 and button 195 engages shim 181 with handle 192.

FIG. 26C illustrates a perspective view of the expansion instrumentengaged with an implant. After the implant has been inserted into theintervertebral disc space, the insertion tool is removed, leaving theimplant and shims in position. The shims and implant are then coupled tothe expansion instrument as seen, and handle 192 and palm handle 197 arealso attached to the expansion instrument. FIG. 26C shows the implantonce expansion is complete. Shims 181 are shown engaged with theimplant, expansion instrument 187, and handle 192. Expansion instrument187 is also shown engaged with handle 192 and palm handle 197. Actuationof palm handle 197 by pushing it forward or distally is used to driveexpansion instrument 187 between the elongated members of the implant tocause expansion thereof.

FIG. 26D highlights the engagement of the shim, expansion instrument andimplant and shows expansion of the implant into the expandedconfiguration.

FIG. 26E illustrates a perspective view of an alternative embodiment ofanother expansion instrument 207. Expansion instrument 207 has a slot208 to translate around centrally located spanning members.

FIGS. 28-32 more clearly illustrate use of the various instruments toinsert and deploy the interbody implant. FIG. 28 shows the removal ofinsertion instrument 183 from the implant after the implant has beenrotated 90 degrees, leaving shims 181 attached to the implant.

FIG. 29 shows the engagement of shims 181 with expansion instrument 187and expansion handle 192. Shims 181 slide through slots 188 of expansioninstrument 187 and slots 196 of expansion handle 192 where button 195locks shims 181 in place.

FIG. 30 shows the engagement of handle 197 via a quick-connect.Expansion instrument 187 slides towards the implant until threadedcomponent 190 engages with expansion handle 192. Handle 197 is then usedto drive expansion instrument 187 towards the implant, separating shims181 and thereby separating the elongated members of the implant as shownin FIG. 31. The final position of the expansion instruments can be seenin FIG. 26C. The expansion instruments can then be disengaged by drivingcomponent 190 away from the implant until threaded component 190 is nolonger engaged with expansion handle 192. Pressing button 195 disengagesshims 181, allowing the user to slide the expansion instruments awayfrom the implant, leaving the expanded implant and shims 181 in place asshown in FIG. 32.

FIG. 31 shows expansion instrument 187 separating shims 181 and therebyseparating the elongated members of the implant.

FIG. 32 shows shims 181 and the implant after expansion and afterexpansion instruments have been removed. Shims 181 can then bedisengaged by pulling them away from the corresponding elongated member,leaving the implant in the expanded configuration.

While preferred embodiments of the present invention have been shown anddescribed herein, it will be obvious to those skilled in the art thatsuch embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the invention. It should be understoodthat various alternatives to the embodiments of the invention describedherein may be employed in practicing the invention. It is intended thatthe following claims define the scope of the invention and that methodsand structures within the scope of these claims and their equivalents becovered thereby.

What is claimed is:
 1. A method of deploying an interbody implant in anintervertebral space surrounded by adjacent vertebral bodies in apatient during a spinal fusion procedure, said method comprising:placing the interbody implant, formed from a plurality of elongatedmembers, within the intervertebral space, said interbody implant havingsuperior and inferior surfaces that have surface features to engagevertebral bodies, wherein the vertebral bodies are configured to beengaged so as to distract the engaged vertebral bodies away from eachother so as to increase the intervertebral space, and increasing a widthbetween medial and lateral surfaces of the interbody implant from afirst position having a first width to a second position having a secondwidth by translating at least two elongated members of the plurality ofplurality of elongated members away from each other, wherein theplurality of elongate members are coupled together with one or morespanning components, and wherein the implant further comprises a pinthat couples a spanning component of the one or more spanning componentsto an elongate member of the plurality of elongate members.
 2. Themethod of claim 1, further comprising: irreversibly increasing the widthbetween medial and lateral surfaces of the interbody implant from thefirst position to the second position by deforming deformation zones ona spanning component of the one or more spanning components.
 3. Themethod of claim 1, wherein placing the interbody implant comprisesplacing the interbody implant into the intervertebral space in a firstconfiguration such that medial and lateral surfaces of the interbodyimplant contact the vertebral bodies within the intervertebral space. 4.The method of claim 3, wherein placing the interbody implant comprisesrotating the interbody implant from the first configuration to a secondconfiguration such that superior and inferior surfaces of the interbodyimplant engage the vertebral bodies within the intervertebral space. 5.The method of claim 4, wherein rotating the interbody implant from thefirst configuration to the second configuration comprises rotating theinterbody implant approximately 90 degrees between the firstconfiguration and the second configuration.
 6. The method of claim 2,wherein the spanning component of the plurality of spanning componentscomprises at least one deformation that is centrally located, andwherein the method further comprises deforming the at least onedeformation zone that is centrally located.
 7. The method of claim 6,wherein the spanning component comprises a first leg and a second leg,wherein a central portion of the spanning component is disposed betweenthe first and second legs of the spanning component, and wherein themethod further comprises deforming the at least one deformation zonethat is located between the first and second legs.
 8. The method ofclaim 7, wherein the first and second legs of the spanning component aresubstantially a same length.
 9. The method of claim 7, wherein the firstleg of the spanning component has a free end, wherein at least onedeformation zone is present at the free end of the first leg of thespanning component, and wherein the method further comprises deformingthe at least one deformation zone at the free end of the first leg ofthe spanning component.
 10. The method of claim 7, wherein the first andsecond legs of the spanning component each have a free end, wherein atleast one deformation zone is present at each free end of the first andsecond legs of the spanning component, and wherein the method furthercomprises deforming the at least one deformation zone present at eachfree end of the first and second legs of the spanning component.
 11. Aninterbody implant for implanting in an intervertebral space surroundedby adjacent vertebral bodies in a patient during a spinal fusionprocedure, said implant comprising: a plurality of elongate members thatform the implant, the plurality of elongate members having superior andinferior surfaces with a height therebetween, and medial and lateralsurfaces having a width therebetween, wherein the superior and inferiorsurfaces are shaped to engage the vertebral bodies, and wherein themedial and lateral surfaces in a first position have a width that is setat a predetermined distance, and wherein the width in a second positionis configured to irreversibly increase by deforming deformation zones,and wherein the plurality of elongate members are coupled together withone or more spanning components, and wherein the implant furthercomprises a pin that couples a spanning component of the one or morespanning components to an elongate member of the plurality of elongatemembers.
 12. The implant of claim 11, wherein the spanning component ofthe plurality of spanning components comprises at least one deformationzone that is centrally located.
 13. The implant of claim 12, wherein thespanning component comprises a first leg and a second leg, and wherein acentral portion of the spanning component is disposed between the firstand second legs of the spanning component.
 14. The implant of claim 13,wherein the first and second legs of the spanning component aresubstantially a same length.
 15. The implant of claim 11, wherein thefirst leg of the spanning component has a free end, and wherein at leastone deformation zone is present at the free end of the first leg of thespanning component.
 16. The implant of claim 11, wherein the first andsecond legs of the spanning component each have a free end, and whereinat least one deformation zone is present at each free end of the firstand second legs of the spanning component.